Just say maybe

For an example of how not to make good health policy, consider the international debate on drugs

HOW should the world control the trade in and use of illicit drugs? As an issue of science and health policy, few questions matter more. In 1998 the United Nations General Assembly held a special session in New York which pledged the “elimination or significant reduction” of drug production and use within ten years. An evaluation of the targets set at that meeting takes place in Vienna this month, at a special ministerial session of the United Nations Commission on Narcotic Drugs. This gathering will hear that the world is no closer to meeting its goals than it was five years ago. But instead of asking such questions as whether the whole project may be misguided, the meeting will almost certainly decide to redouble international efforts to achieve the unachievable.

The framework for global drug policies is set by three UN conventions, dating from 1961, 1971 and 1988. Between them, these conventions set rules prohibiting, in almost any circumstances, the production, manufacture, trade, use or possession of potentially harmful plant-based and synthetic non-medical drugs, other than tobacco and alcohol. Crucially, these conventions go far beyond the bounds of most international treaties in the extent to which they dictate signatories' domestic policies as well as international relations. For example, the 1988 convention insists that signatories pass legislation to make the possession of drugs for personal consumption a criminal offence. That means they are, on the face of it, prevented from experimenting with the idea that controlled, permitted use may be less harmful than the side-effects of prohibition.

Plenty of non-governmental organisations (NGOs) and even some government ministers (in private, at least) now recognise that these treaties and the policies they encourage are the wrong way to tackle drug abuse. Unfortunately, those arguments look unlikely to make any headway in Vienna.

Turned off

The arguments for a different approach have grown stronger, not weaker, since 1998. The failure of the current policy has become much clearer. There is no sign that government intervention has cut supply, although it may sometimes divert it. For instance, the opium crop fell sharply in Afghanistan in 2001, under the Taliban government, but it rebounded last year after the American invasion (see chart). Meanwhile, according to Francisco Thoumi, a member of Colombia's Academy of Economic Sciences, Colombia's aggressive policies, aimed at wiping out the coca crop, have merely led to an increase in planting in Bolivia, where a coca grower almost won the recent presidential election, and in Peru. There is, says Dr Thoumi, no evidence of a decline in the availability of cocaine in the United States. Instead, the drug's purity seems to have increased.

There is plenty of evidence of broader failure too. The UN's meeting in 1998 set no benchmarks by which to judge progress. Success is judged by which programmes are in place, rather than by what they achieve. Thus a country that has plans to eradicate illicit crops can tick the appropriate box, even if the plan eradicates nothing. (And according to Anthony White, a British drug analyst, many countries have not even bothered to say which boxes they have ticked.) Back in the real world, the numbers tell a different story. Some recently released American figures show that more land in Latin America was planted with coca in 2002 than in 1998. Figures from the UN's Office on Drugs and Crime (ODC) show the retail price of heroin falling in the European Union (see chart overleaf). The use of Ecstasy among American and Canadian high-school students is rising. And so on.

In the light of this, a few governments—mainly European, but also those of Canada and Australia—are getting fed up with the treaties' emphasis on zero tolerance. Instead of prohibition, they are keen to emphasise “harm reduction”: to accept that drug-taking cannot be prevented, and instead to concentrate on reducing its consequences for health and crime.

The relentless rise of AIDS in intravenous drug users has been an important spur to this change of attitude. Switzerland has set up centres where heroin users can receive daily doses, together with medical treatment, and has seen drug-related deaths and crime diminish as a result. Britain may return to prescribing heroin to users, as it did until 35 years ago.

Britain has also skirted the intent of the treaties by deciding, as an experiment in part of London, not to enforce the law banning the possession of cannabis when an individual is carrying that drug for personal consumption. Jamaica, Spain and Portugal have gone further, extending such experiments to the whole country. And the Netherlands has long been noted for its tolerance of soft drugs.

So there is a case for considering change, and for allowing a coalition of the willing to experiment. Unfortunately, that is unlikely to cut much ice in Vienna. The main reason is the powerful anti-change lobby, led by the United States, whose attitudes and actions sometimes take on the ferocity of a medieval witch hunt.

Tuned out

The “no-change” lobby's watchdogs are the two bodies that actually manage the treaties: the ODC, which administers them, and the International Narcotics Control Board (INCB), which monitors breaches of them. In its annual report, published in February, the INCB attacked the “crusade” to encourage harm reduction. It singled out Britain's approach to cannabis for special condemnation. The INCB did this despite having recently received legal advice from the ODC that harm-reduction approaches might conform with the UN treaties. The INCB attack drew a furious retort from Bob Ainsworth, a British minister, who complained about “the alarmist language used, the absence of any reference to the scientific evidence on which that decision was based, and the misleading way in which the decision was presented by the INCB”.

As for the ODC, its culture is inherited from the UN International Drug Control Programme (UNDCP), which it recently swallowed. That body was a byword for bad management and internal strife. Two years ago, one of its senior staff described it as a “snake pit” (and then left). Pino Arlacchi, its last executive director, was eased out after an auditors' report exposed serious mismanagement, and a lot of other top staff have either departed in despair or been pushed out. In one of several articles on the forthcoming meeting in the latest issue of the International Journal of Drug Policy, Cindy Fazey of Liverpool University, in England, describes the power wielded over the organisation by the main donors, especially the United States. In her time, she says, “punishment postings were not infrequent, to places such as Yangon, Myanmar; Lagos, Nigeria; Dakar, Senegal...the result is that many UNDCP staff are in constant fear of their jobs.”

The ODC now has a new director, Antonio Costa, a former secretary-general of the European Bank for Reconstruction and Development. So things may change. But whatever the international agencies think, plenty of countries that have signed the three conventions are vehemently opposed to any liberalisation.

America is easily the most powerful of these. Under the presidency of George Bush, says Ethan Nadelmann, executive director of the Drug Policy Alliance, an American lobbying group, prospects for even modest reform are bleaker than they were under his father's presidency. America has the power to make life miserable for any developing country that does not share its enthusiasm for suppressing drugs, and does not hesitate to use it.

America is not alone, though. Islamic countries share its hostility even to the legalisation of cannabis, as do Russia, China and Japan. Even within the European Union, member states are split in ways that have made it impossible for the organisation to form a common ministerial view. Spain, Portugal and the Netherlands may be liberal, but Sweden has long backed zero tolerance. The governments of Italy, Ireland and France are also tough-minded. Jacques Chirac, in particular, is an old anti-drug warrior.

In early March Greece, which currently holds the EU presidency, called a conference to discuss EU views in advance of the Vienna meeting. It was composed of a mixture of national representatives, free-floating experts and NGOs. The conference, at which rationality mainly prevailed over ideology and rhetoric, ended in anger. The French delegation savaged the Greek hosts for daring to allow government delegations to mix with liberal opinions, and for producing a conference report that recorded both doubt and debate. That bodes ill for Vienna.

Dropped in?

It is just possible, though, that the impasse can be broken. One striking change since 1998, notes Mike Trace, Britain's former deputy drug tsar, is that NGOs have begun to moderate their demands. Five years ago, these lobbyists clamoured for an end to all restrictions on drug use and trade, encouraging defensiveness on the other side. Now, the debate has become more sophisticated, with the lobbyists willing to explore other, more flexible, approaches.

One possibility, suggests Martin Jelsma, of the Transnational Institute, a Dutch think-tank, is the creation of an informal alliance of countries keen on more flexibility. Three groups might come together: Commonwealth countries such as Britain and Canada that want a pragmatic approach to cannabis; European countries such as Germany and Switzerland that are keen on harm reduction and open debate; and Latin American countries such as Brazil and Bolivia which are desperate for a better way to deal with the curse of cocaine. But sooner or later, such an alliance would still have to deal with the conventions. These have been signed by well over 100 countries, and cannot lightly be altered or set aside. The path to a rational drug policy is likely to be a long one.